Natural history of acute HCV infection in hemodialysis patients

Espinosa, Mario; Martín‐Malo, Alejandro; Lara, María Antonia Alvarez de; González, R.; Rodríguez, Miguel; Aljama, Pedro

doi:10.5414/cnp58143

Cited by 47 publications

(43 citation statements)

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“…The increased ALT activity can be very small and very transient. The percentage of acute HCV infection leading to chronic infection without treatment in our study (71.4%) was similar to that reported in other studies on chronic hemodialysis patients [Okuda et al, 1998;Espinosa et al, 2002] or patients with normal renal function [Kenny-Walsh, 1999;Rodger et al, 2000;Barrett et al, 2001;Orland et al, 2001].…”

Section: Discussionsupporting

confidence: 79%

“…However, all the infections were asymptomatic. As in the general population, acute HCV infection is very often asymptomatic [Hung et al, 1995;Orland et al, 2001;Espinosa et al, 2002] and no case of fulminant hepatitis has been reported so far. The increased ALT activity can be very small and very transient.…”

Section: Discussionmentioning

confidence: 99%

“…There is a need to identify rapidly new infections and limit the risk of patient-to-patient transmission of infection by reviewing hemodialysis unit procedures and by considering anti-HCV treatment for newly infected patients, that is, alpha-interferon (a-IFN) therapy. Although treatment with a-IFN is effective in patients infected chronically with HCV on dialysis [Kamar et al, 2003;Russo et al, 2003], few data are available on its effectiveness during the acute stage of HCV infection in hemodialysis patients [Gursoy et al, 2001;Espinosa et al, 2002].…”

Section: Introductionmentioning

confidence: 99%

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Incidence of HCV infection in French hemodialysis units: A prospective study

Izopet

Sandres-Sauné

Kamar

et al. 2005

Journal of Medical Virology

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A large prospective study was carried out from 1997 to 2000 in 25 French hemodialysis units including 1,323 patients to determine the incidence of hepatitis C virus (HCV) infection. Monthly testing of alanine aminotransferase (ALT) activity, and assessment of HCV RNA and anti-HCV antibodies if the ALT activity was elevated, identified 14 new infections in 7 different units, giving an incidence of 0.4% new HCV infections per year. Molecular analyses and epidemiological data indicated that five patients became infected with HCV outside the unit where they were dialyzed, while the nine remaining patients acquired HCV from infected patients on dialysis during the same shift at the same unit. HCV was cleared in six of the seven (85.7%) patients with acute hepatitis C who were given standard doses of alpha-interferon (alpha-IFN). The persistence of nosocomial transmission of HCV in hemodialysis units emphasizes the need to implement infection control practices. Identifying new infections is crucial because alpha-IFN treatment results in long term clearance of HCV RNA in a large proportion of patients.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence of HCV infection in French hemodialysis units: A prospective study

Izopet

Sandres-Sauné

Kamar

et al. 2005

Journal of Medical Virology

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“…Nevertheless, a Spanish study reported that 3 years after acute hepatitis C infection, 87.5% of hemodialysis patients remained HCV-RNA positive [Espinosa et al, 2002].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a total core antigen assay for the diagnosis of hepatitis C virus infection in hemodialysis patients

et al. 2005

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Hemodialysis patients are recognized as a group at high risk of infection with hepatitis C virus (HCV). Therefore, such a population should be screened routinely for the presence of HCV viremia. Since nucleic acid techniques remain expensive and largely unavailable in many laboratories in the developing world, the present study assesses the clinical usefulness of the HCV core antigen enzyme immunoassay for the diagnosis of HCV infection in dialysis patients. One hundred seventy-five dialysis patients were screened for the presence of anti-HCV antibodies and HCV RNA in the serum. One hundred twenty-eight serum samples were collected from the 76 patients who were anti-HCV antibody- and/or HCV RNA-positive. These were evaluated for total HCV core antigen. Of these samples, 55 had sufficient volume to be further tested to quantify HCV RNA by reverse transcription polymerase chain reaction (RT-PCR). Genotyping of the HCV strains showed that the majority belonged to genotype 1b (77%). The HCV core antigen assay showed a sensitivity and specificity of 84% and 89%, respectively. The use of core antigen assay has enabled the early detection of three patients who developed an acute hepatitis C infection during the period of study. A correlation study was undertaken between the quantitative values of viral load, expressed as pg/ml of HCV core antigen in serum, and viral RNA in UI/ml. A significant correlation was observed (Pearson's correlation coefficient: 0.552; P<0.001). In conclusion, detection of HCV core antigen in serum is an inexpensive, reliable, and highly specific assay that can be useful in most laboratory settings to diagnose HCV infection, and especially in laboratories where nucleic acid technologies are not yet available.

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“…In two studies including 19 and 32 patients with acute hepatitis C under hemodialysis, the peak median ALT levels of the patients were 345 IU/l (range: 24-1,473) [8] and 169 IU/l (range: 22-325), respectively. Another study used the definition of acute HCV infection as ''a rise of twice the normal or more of serum ALT level compared to baseline in addition to a positive serum anti-HCV antibody'' [4].…”

Section: Dear Sirmentioning

confidence: 99%

Recognizing Acute Hepatitis C in Hemodialysis Patients

et al. 2008

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Dear Sir,Hepatitis C virus (HCV) infection is common in hemodialysis patients and the relatively lower alanine aminotransferase (ALT) values in acute [1] and chronic hepatitis C infections [2, 3] of these patients make the diagnosis more difficult. Acute hepatitis C in hemodialysis patients can be treated by interferon (IFN) therapy [4], although the response rates are lower than in patients with normal renal function [5].Lampe et al.[6] emphasized the role of recognizing acute HCV infection in hemodialysis patients by comparing the ALT level to the patient's ALT baseline values.A 53-year-old male was under hemodialysis for 10 years due to hypertensive nephropathy. Hemodialysis was applied 3 times weekly and the serology of HCV and hepatitis B virus (HBV) and biochemistry were checked monthly. When his ALT level was measured as 29 U/l, which seemed significantly higher than his previous measurements (4, 5, 7, 4, and 6 IU/l, respectively), HCV and HBV serology was repeated. Although anti-HCV remained negative and anti-HBs was positive, his ALT level was serially checked. Within 1 month, his ALT level increased to 114 U/l and anti-HCV was detected as positive. He remained symptomless. HCV ribonucleic acid (RNA) by polymerase chain reaction (PCR) was measured as 7,130 IU/l and the genotype study remained an indeterminate result. HCV RNA studies obtained 2 weeks apart gave comparable results of 5,150 and 6,120 IU/l. His ALT level increased to a maximum level of 155 U/l and then tended to decrease (Fig. 1). He was initiated with pegylated IFN alpha-2a 135 lg weekly.

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Natural history of acute HCV infection in hemodialysis patients

Cited by 47 publications

References 0 publications

Incidence of HCV infection in French hemodialysis units: A prospective study

Incidence of HCV infection in French hemodialysis units: A prospective study

Evaluation of a total core antigen assay for the diagnosis of hepatitis C virus infection in hemodialysis patients

Recognizing Acute Hepatitis C in Hemodialysis Patients

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